Fahl TRACHEOTEC Instrucciones De Uso página 19

Next, push a tracheal compress onto the tracheostomy tube.
To facilitate insertion of the tracheostomy tube, it is advisable to lubricate the outer tube by wiping it
with an OPTIFLUID stoma oil wipe (REF 31550) which allows the stoma oil to be applied evenly to the
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whole surface of the tube (see picture 4a and 4b).
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If you are inserting the tube yourself, use a mirror to make insertion of the Fahl tracheostomy tube
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easier.
When inserting the Fahl tracheostomy tube, hold it by the neck flange with one hand (see picture 5).
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Pull the tracheostoma slightly apart with your free hand to allow the tip of the tube to fit into the trache-
ostoma more easily.
Special aids for dilating the tracheostoma are also available (tracheal dilator). These allow the tra-
cheo-stoma to be dilated gently and evenly, for instance also in emergency situations with collapsing
tracheo-stoma (see picture 6).
Make sure that the tube is not damaged by friction when using an instrument for assistance.
Now carefully insert the tube into the tracheostoma during the inspiration phase (while breathing in)
while tilting your head slightly back (see picture 7).
Advance the tube into the trachea.
Straighten your head once the tube has been inserted further into the trachea.
If an obturator is used, this must then immediately be removed from the tracheostomy tube.
The tracheostomy tubes should always be attached with a special tube holder. This stabilises the tube
and thus ensures that the tracheostomy tube is securely seated in the tracheostoma (see picture 1).
1.1 Inflating the cuff (if such exists)
The cuff is inflated by applying a defined pressure to the cuff via the Luer connection (standardised
conical connection) of the inflation tube by means of a cuff pressure gauge. If not instructed otherwise
by the doctor/physician, we recommend a cuff pressure of at least 15 mmHg (20 cmH O) to 18mmHg
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(25 cmH O). The cuff pressure should never under any circumstances exceed 18mmHg (approx.
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25 cmH O).
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Inflate the cuff at most to this target pressure and check to make sure that sufficient air is supplied via
the tracheostomy tube.
Always make sure that the cuff is undamaged and is functioning faultlessly.
If the desired sealing is not achieved even after repeated attempts with the specified limit volume, a
tracheostomy tube with larger diameter may be indicated.
The correct cuff pressure must be checked regularly, i.e. at least every 2 hours.
CAUTION!
All instruments used for inflating the cuff must be clean and free of foreign particles! Detach the
instruments from the Luer connection of the inflation tube as soon as the cuff has been inflated.
CAUTION!
If the maximum pressure is exceeded for longer periods of time, the blood circulation in the
mucus membrane can be impaired (risk of ischaemic necrosis, pressure ulcers, tracheoma-
lacia, tracheal stenosis, pneumothorax). In patients undergoing artificial respiration, the cuff
pressure should not be allowed to drop below the cuff pressure value specified by the doctor/
physician in order to prevent unnoticed aspiration. Hissing noises in the region of the balloon,
especially during expiration, indicate that the trachea is insufficiently sealed by the balloon. If
the trachea cannot be sealed with the pressure values specified by the doctor/physician, the en-
tire air should be withdrawn again from the balloon and the sealing process should be repeated.
If this does not lead to success, we recommend to use the next larger tracheostomy tube with
balloon. Due to the permeability of the balloon wall for gases, it is normal for the pressure in
the balloon to decline slightly over time, but it can on the other hand also rise unintentionally
during gas anaesthesia. Regular pressure monitoring is therefore urgently recommended.
The cuff must never under any circumstances be inflated with excessive amounts of air, since
this can lead to damage of the tracheal wall, tears in the cuff with subsequent deflation, or
deformation of the cuff, in which case airway obstruction cannot be ruled out.
CAUTION!
During anaesthesia, the cuff pressure can rise/fall due to nitrous oxide (laughing gas).
2. Removing the tube
CAUTION!
If the tracheostoma is unstable, or in emergency situations (puncture/dilation tracheostomy),
the tracheostoma can collapse after withdrawal of the tracheostomy tube, thereby impairing air
supply. A fresh tracheostomy tube must be kept ready for use in such cases and must be quick-
ly inserted if necessary. A tracheal dilator can be used for temporarily securing the air supply.
The cuff must be emptied before removing the tracheostomy tube. The head should be tilted
back slightly for removal of the tube.
CAUTION!
Never use a cuff pressure gauge to empty the cuff. Always use a syringe for this.
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